Healthcare Provider Details

I. General information

NPI: 1134630916
Provider Name (Legal Business Name): CARRIE ANIELLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OLD CAMP RD STE 210
THE VILLAGES FL
32162-5605
US

IV. Provider business mailing address

36703 ALAQUA CT
EUSTIS FL
32736-7953
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-3356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9308475
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9308475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: